Under one, 1.42; one to five, 1.92; five to ten, 0.49; ten to fifteen, 0.33; fifteen to twenty, 0.61; twenty to thirty, o. 74; thirty to forty, 0.88; forty to fifty, 1.04; fifty to sixty, 1.52; sixty to seventy, 3.12; seventy to eighty, 6.78; over eighty, 17.50.

Comparing these figures with those upon which Diagram No. 3 is constructed, we find that, were it not for consumption, the mortality rates between the ages of fifteen and forty would be greatly reduced; in fact, that period of life could be considered almost exempt, as it should be, from fatal diseases.

Diagram No. 5 shows the percentages of deaths from consumption for the years 1885, 1886, 1887, by counties, to the total mortality of those counties. The uneven distribution of the disease is to be accounted for only after the consideration of many factors affecting different localities. A low elevation and soil moisture doubtless have much to do with the high rates of Rockingham and Strafford counties, while the low rate of Coös is from a reverse topographical condition, with a larger area of forests and different atmospheric conditions. To account specifically for the variations exhibited in the diagram, the exemption from and prevalence of other diseases would have to be considered. For instance, in Hillsborough county the mortality rate from consumption in children under five years of age is doubtless greatly reduced by the heavy mortality rate from cholera infantum; in like manner, the mortality rate from consumption varies in other localities. The diagram is simply given to present the actual facts, rather than to enlarge, at this time, upon the causes that are responsible for the variations exhibited.

A study of the death rate from consumption by seasons, seems to show that there is no very marked variation from month to month. For the past three years the rate is as follows: January, 288; February, 235; March, 232; April, 234; May, 252; June, 231; July, 198; August, 177; September, 173; October, 208; November, 198; December, 182. The greatest number of deaths was in May and the fewest in September. There is a sameness in the mortality of consumption by months, not characterized by any other disease.

Diagram No. 6 shows the mortality from consumption during the past year (1887) by weeks, the greatest number of deaths occurring in the last week of October, and the least number in the second week of August.

A glance at diagram No. 7, showing the deaths from acute lung diseases for the same period, shows vividly an effect of season, which is not manifest in pulmonary consumption. This diagram includes pneumonia, acute bronchitis, asthma, and pleurisy.

The death rate by sex in consumption is larger among women. During the past three years the mortality by sex is as follows: males, 1,051; females, 1,369. This is readily accounted for, from the fact that women are subject, to a far greater extent than men, to the evils of non-ventilated living rooms, as well as to the pernicious influences of other unsanitary surroundings.

Occupation, no doubt, has its influence in developing the disease; but our registration does not yet cover a sufficient number of years to present any facts of value upon this subject.

From a careful study of this disease in New Hampshire for the past six years, but more especially from the registration returns of the years 1885, 1886, and 1887, the following conclusions are arrived at:

1. The disease prevails in all parts of the State, but is apparently influenced by topographical conditions, being greater at a low elevation with a maximum soil moisture, than in the higher elevations with a less moist soil. The prevalence of other diseases also affects the death rate from consumption.

2. That the season has only a small influence upon the mortality from this disease. The popular idea that the fatality is greatest in the winter is shown to be erroneous, the greatest number of deaths occurring in May.

JAN.

FEB.

MAR. APR. MAY.

JUN. JUL. AUG. SEP. ogt.. NOV.

DEC.

sex.

3. That the mortality is considerably greater in the female

4. That no age is exempt from the disease, but that the least liability of its development exists between the ages of two and fifteen, and the greatest between twenty and thirty. Advanced age does not assure any immunity from the disease, as is generally supposed, but the smaller number of decedents is due to the fewer living persons of that advanced period of life.

5. The death rate from pulmonary consumption is relatively much the larger among the foreign born.

6. The average death rate from consumption for the years 1885, 1886, and 1887 is 12.86 per cent of the total mortality of the State. In Massachusetts, for the ten years ending 1886, deaths from consumption averaged 16.10 per cent of the total mortality; and in Rhode Island, for a period of twenty-five years ending 1884, 16.30 per cent. This shows a greater freedom from the disease in New Hampshire than in the two States mentioned.

In this very brief paper, prepared in great haste, I have attempted to show only a few leading and important facts relating to pulmonary consumption. In military warfare, it is necessary to know the strength of the enemy in numbers, how he is fortified, from what direction he is likely to make an attack, or how garrisoned, in order to be assured of a reasonable chance of success in repelling his advance or of capturing his position. To rely upon the gun and sword without this knowledge, would be to invite defeat from the start. So in dealing with the fearful disease under consideration, it is necessary that the physician shall have a full knowledge of the foundation upon which is reared this appalling structure of death. Prescriptions of codliver oil, etc., alone, will check this advancing enemy of death with no greater rapidity than the rain will wash away the eternal rock of Gibraltar.

The mortality from pulmonary consumption has already been reduced during the present generation in New England; but the reduction has been secured through a better knowledge of how to avoid it, rather than from any system of medication. By a well-directed application of the preventive knowledge which has been gained by a study of the history of the disease, its rate of fatality should be greatly lessened in the future.